Wiki Units billable for radio pharmaceutical drugs.

[ATMOCH88]

I was wondering if you bill for the total dose for the patient including any residual amount that may not be actual administered into the patient in tubing etc. For instance... our techs document the Initial dose (total), the residual , and the amount the patient actually received in their body. Which one do we base our units off of? I am receiving a lot of conflicting information plus our MAC has paid them both ways even when over the Maximum dose limit that we sent a redetermination in for with records that clearly list the drug amounts as i stated above. Does anyone know of any guidelines that clear this up? we cannot locate anything concrete from a legit source.

thank you!

 

[rachaelwilleford]

Single dose vial - you'd bill the administered amount on one line and then the "wasted" (non-administered) amount is billed on a separate line with a JW modifier.
Multi dose vial you can only bill what was administered since the remainder can still be used.

Since most drugs are sold in both capacities, the MAC is showing billing for both.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/JW-Modifier-FAQs.pdf